Title:	Public Health Systems - Challenges and Opportunities: the Case of Nepal
Keywords:	Universal health coverage Public Health Primary Health Care Health systems Essential health care package
Country:	Germany
Institution:	Germany - Center for International Health at the Ludwig-Maximilian-Universität München
Course coordinator:	Sarah Scholze Deepak Paudel
Date start:	2024-04-29
Date end:	2024-05-03
About duration and dates:	Registration Deadline: 2024-04-14;One week with four full days in class, one half day for joint field trip exposure to the Pharping Community Health Facility. Pre-reading will be issued two weeks prior to course beginning. Post-course assignment is due two weeks after the after the end of the course
Classification:	advanced optional
Mode of delivery:	Face to face
Course location: Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal Website: https://www.cih.lmu.de/public-health-systems
ECTS credit points:	3 ECTS credits
SIT: Pre-Reading Assignment, self study: 10 hours Interactive lectures face-to-face: 35 hours Field trip with group work: 6 hrs Tutored Group work: 4 hours Individual assignment after course week: 35 hrs Total SIT: 90 hours
Language:	English
Description: At the end of the module the student should be able to … ● ● explain and evaluate the health care delivery system in Nepal ● identify major sources of health-related information and explain what role they play in influencing health decisions ● assess major health problems including challenges and opportunities to address those problems ● identify socio-cultural aspects of care seeking, service delivery and health behaviors ● discuss innovations and initiatives taken to address these health problems both from supply side and demand side ● compare challenges pertinent to health care systems in both developed and developing countries (HICs vs. LMICs) ● demonstrate possible health system solutions in a resource constrained system.
Assessment Procedures: ● Individual post-course assignment after course week: students will select a public health topic/issue that is of their interest (preferably the same one as selected for the individual presentation during the course) and prepare an essay (word count 2000 to 3000). Possible topics are e.g. maternal health, child health, neonatal health, non-communicable diseases, injuries and road traffic accidents. The essay will be rated by the Nepalese course facilitator (Grading A-D, F) ● The minimum pass mark for the post-course assignment is 60% In case of failure, students will be assigned another 2000 to 3000-word essay on a topic as defined by the facilitators. This can be resubmitted within two weeks after the failed post-course assignment.
Content: ● An overview of the Public Health delivery system in Nepal. ● Comparison of health care systems in different resource settings, countries and regions. ● Public Health System interventions to address health problems in Nepal. ● Comparison of financing systems in different resource settings, countries and regions. ● Health System challenges in Nepal from supply side (health system) and demand side (community and users). ● Opportunities such as innovations or community-based approaches to health system challenges in Nepal ● Socio-cultural aspects and determinants of health care seeking behaviour and service delivery in Nepal.
Methods: - Pre-course Reading Assignments as self-study: ● Participants receive pre-course reading assignments (2-3 peer reviewed journal papers, 1 chapter from Annual Report of Ministry of Health, 1 project brief / report focusing any health system issue in Nepal) ● Readings will be essential for students to follow the course (10 hours) and will be linked with the group work and discussions - - Interactive lectures that are held face-to-face with discussions (35 hours) - - - Field exposure to a health facility and community including group work after virtual field exposure (6 hours) - Tutored Group Work (4 hours) - Individual post-course assignment (35 hours) ● Student are asked to write an essay based on the inputs provided and reference documents shared by facilitators (20 hrs) ● Further reading as suggested by facilitators that should assist with the individual essays (15 hrs)
Prerequisites: Proof of English fluency: tropEd students from an accredited tropEd home institution who have passed a core course in English language will be considered sufficiently fluent in English language. Also students who can provide proof of academic education passed entirely in English language will be considered sufficiently fluent. Applicants not being able to provide either of these criteria will be asked to proof fluency by a TOEFL (iBT score >= 79) or IELTS (score >=6.0).
Attendance: Max. number of participants: 15; Up to 10 tropEd Master’s students are admitted Minimum number of students for the course to run: 5
Selection: International students are selected on a first-come, first-serve basis Local students in Nepal will be selected on merit basis (degrees, grades, professional qualification by the Nepalese coordinator)
Fees: € 600 for international students, Nepali students from partner institution participate for free
Scholarships: not available
Major changes since initial accreditation: The Multiple Choice exam was deemed unnecessary and in combination with the post-course assignment too much in general. As the learnings were best assessed within the post-course assignment, this was kept. Group work and field trip were extended as well.
Student evaluation: ● The different time zone is a big hiccup of the online format. Therefore, it might be challenging participants to remain fully awake throughout the all session. ● I think that the virtual field visit did not give a clear update of the current health challenges in the same community. So I felt a gap in my understanding ● For a better understanding of the context, an interaction with local peoples is beneficial ● For me, the highlights were the field visit to the Pharping community health facility, the community based approaches to address health problems and the health system challenges in Nepal: demand and supply issues ● I liked best the content of the topics and the presenters who were happy to discuss. ● Field visit must be kept in the future
Lessons learned: During the pandemic the course was conducted as an online course. We quickly learned that the course contents are best delivered in-presence though not only to the nature of the topic but also due to the incorporated field trip, local panel discussion and exchange with international students.
tropEd accreditation: Accredited in April 2018 and in Witten in June 2023. This accreditation is valid until June 2028.
Remarks: Key reading (examples) Annual Report of DOHS: http://dohs.gov.np/wp-content/uploads/2017/06/DoHS_Annual_Report_2072_73.pdf Key system resources from Nepal: http://nhsp.org.np/documents/ http://nhsp.org.np/category/nhss/ http://www.nhssp.org.np/thematic_rpt.html http://www.mohp.gov.np/content/policies-and-strategies Data sources: Demographic and Health Survey, Service Provision Assessment http://www.dhsprogram.com/Where-We-Work/Country-Main.cfm?ctry_id=13&c=Nepal&Country=Nepal&cn=&r=4 World Bank Nepal https://data.worldbank.org/country/nepal IHME/GBD Nepal http://www.healthdata.org/nepal http://vizhub.healthdata.org/gbd-compare Peer reviewed journal papers: Drivers of health system strengthening: learning from implementation of maternal and child health programmes in Mozambique, Nepal and Rwanda https://academic.oup.com/heapol/article-abstract/32/7/1015/3803450/Drivers-of-health-system-strengthening-learning?redirectedFrom=fulltext Newborn survival in Nepal: a decade of change and future implications https://academic.oup.com/heapol/article/27/suppl_3/iii57/584074/Newborn-survival-in-Nepal-a-decade-of-change-and?searchresult=1 The national free delivery policy in Nepal: early evidence of its effects on health facilities https://academic.oup.com/heapol/article/26/suppl_2/ii84/643333/The-national-free-delivery-policy-in-Nepal-early?searchresult=1 Healthy mothers, healthy children: does maternal demand for antenatal care matter for child health in Nepal? https://academic.oup.com/heapol/article/26/3/242/569101/Healthy-mothers-healthy-children-does-maternal?searchresult=1 Governance challenges in the Nepalese primary health care system: time to focus on greater community engagement? http://onlinelibrary.wiley.com/doi/10.1002/hpm.2290/abstract Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016 http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)31833-0.pdf
Email Address:	ttu@lrz.uni-muenchen.de
Date Of Record Creation:	2018-04-14 02:18:05 (W3C-DTF)
Date Of Record Release:	2018-04-14 06:32:54 (W3C-DTF)
Date Record Checked:	2021-04-13 (W3C-DTF)
Date Last Modified:	2023-11-30 13:57:13 (W3C-DTF)